Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Support Services for
Military Kids & Families
Presented by:
Mona M. Johnson MA, CPP, CDP
Director School Behavioral Health
US Army Medical Command
Child, Adolescent & Family Behavioral Health Proponency
Mona.m.johnson1@us.army.mil
http://brainhealth.army.mil/SBH
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
• What do we know
about the effects of
War on Military
Children, Youth and
Families?
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Data on the Army Challenges
•
Inadequate TRICARE resources in most areas near installations
•
Effect of War/ Deployment on Children and Families
 1 of 3 school-aged child at risk for psychosocial problems. About 33% of
children have significantly increased anxiety
 Psychological problems of parents predicts problems in children
 Cumulative length of deployment increases child’s risk of depression and
externalizing symptoms—stress builds in across wartime deployments in parents
and children 1,2
 Children 3 years and older of have significantly more behavioral problems 2,3
 Increases in Child Maltreatment 4
 Increases in Youth referrals
• TAMC—89 / 326 (27%) related to OIF and/or OEF5
• Schofield—126 / 206 (61%) related to OIF/OEF6
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
The “New” Emotional Cycle of Deployment
• Each stage is characterized by time frame and specific
emotional challenges
• Failure to negotiate successfully can lead to strife
• Seven distinct stages:
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Stage One: Anticipation of Departure
Stage Two: Detachment & Withdrawal
Stage Three: Emotional Disorganization
Stage Four: Recovery & Stabilization
Stage Five: Anticipation of Return
Stage Six: Return Adjustment & Renegotiation
Stage Seven: Reintegration & Stabilization
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage One:
Anticipation of Departure
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Timeframe: When family members receive orders
Increased feeling of stress in home
Reality of change ahead is “sinking in”
Denial & anticipation of loss
Focus is on completing family pre-deployment activity
checklist
• Members may feel more emotional
• In case of multiple deployments . . . new cycle may begin
before family has had time to renegotiate shared vision from
last deployment
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Two:
Detachment & Withdrawal
• Timeframe: Last week before Service Member leaves
• Service Member is focused on preparing for mission and may
distance self from family
• Anger, arguments may occur as family prepares to protect
themselves from “hurt” of separation
• Communication may be difficult
• In preparation for loss, family may begin to act like Service
Member is already gone
• Multiple deployments can result in need to repeatedly
create distance; to feel “numb” and avoid emotional
connection
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Three:
Emotional Disorganization
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Timeframe: 1-6 weeks into deployment
Life without Service Member may initially feel overwhelming
Routines change, responsibilities added
Kids may feel . . .
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Numb and not interested in doing much
More irritable than usual
Have difficulty concentrating – particularly at school
Wish things would go back to “normal”
Surprised because things seem to be moving more smoothly
now that Service Member is gone
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Four: Recovery & Stabilization
• Timeframe: Usually between weeks 3 and 5 after deployment
• Family finally starts to settle into routine of life without
Service Member
• Coping with changes can be positive for kids
– May enjoy new found responsibilities
– Sense of independence
– Relief that family is functioning well
• Coping with changes can be challenging for kids
– Difficult time accepting changes
– Stressed, depressed, and having difficulty getting things done
– Feel unsupported and worried how will make it through
• Most of the time there is a mixture of both responses!
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Five: Anticipation of Return
• Timeframe: About 6 weeks before the Service Member
Returns
• Homecoming is coming!
• Family is happy, excited, and feeling boost of energy
• Trying to make everything “perfect” for return
• Sense of relief that Service Member will be home combined
with worries about whether or not they will be the same
• If Service Member came home on leave at some point
during deployment, that experience may be what family
members expect:
– Positive Leave Experience = Positive Homecoming
– Challenging Leave Experience = Challenging Homecoming
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Six: Return Adjustment
and Renegotiation
• Timeframe: About 6 weeks after the Service Member returns
• During time of separation Service Member and all family
members have changed
• Changes may hold pleasant surprises or may cause conflict
• Family members may feel overwhelmed by Service Member
attempts to get to know everyone again
• Everyone needs space and time to readjust
• Entire family must begin to renegotiate how household will
look now that everyone is together again
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Stage Seven: Reintegration & Stabilization
• Timeframe: Up to 6 month (and beyond) after the Service
Member returns
• Family continues to adjust to having Service Member home
• A “new normal” is established regarding routines and
expectations
• Members may begin to feel secure, relaxed, and
comfortable with one another again
• If readjustment challenges resurface, support is important. .
. It’s okay to ask for help if you need it!
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Deployment/Reunion Stress Related Issues
• Combat Stress - Term used to describe “normal physiological,
behavioral, and psychological reactions experienced before,
during, or after combat”
• Traumatic Brain Injury (TBI/mTBI) - “ Occurs when a sudden
trauma causes focal or diffuse damage to the brain; Type of
concussion; Physical damage not always visible.”
• National Institute of Health and Dr. Kris Peterson, Madigan Army Medial Center
•Post Traumatic Stress - “A psychiatric disorder that occurs after
witnessing life-threatening events such as military combat,
natural disasters, terrorist incidents, serious accidents, or
violent personal assaults like rape.” National Center Post Traumatic Stress Disorder
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Deployment/Reunion Stress
Related Issues for Families
• Compassion Stress
• Stress resulting from helping or wanting to help a suffering
or traumatized person
• Compassion Fatigue
• A state of exhaustion and dysfunction, biologically,
physiologically, and emotionally, as a result of prolonged
exposure to compassion stress
• Compassion Satisfaction
• A powerful sense of satisfaction with trauma work;
Development of personal strengths and feelings as a
result. –Dr. Charles Figley
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Strengths for Children & Youth
Resulting From Deployment
• Physical, mental, emotional and social development is
appropriate for age and stage of infant/child/youth
• Able to connect with parents/caring adults
• Fosters maturity
• Encourages independence, flexibility, adaptability
• Builds skills for adjusting to separation
and losses faced later in life
• Strengthens family bonds
• Civics—relationship with community
•Able to identify and verbalize feelings
•What other strengths may result
from deployment?
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Symptoms of Deployment/Reunion
Stress In School Setting
•Unable to resume normal
class assignments/activities
•Continued high levels of
emotional response (i.e.,
crying and intense sadness)
•Difficulty concentrating in
school
•Express violent or depressed
feelings verbally or through
drawings/play
•Intentionally hurt self or
others
•Gain or lose significant
amount of weight in period
of weeks
•Discontinue care of personal
appearance
•Exhibit possible alcohol/drug
abuse problem
•Frequent absences
•Experience decline in
performance and grades that
does not improve over time
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
The Impact of Multiple Deployments & Stress
Behaviors
Reactions
Communication
Interactions
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Infant to 5 Years: Signs of Stress
• Behaviors
• Fussiness, uncharacteristic crying, neediness
• Generalized fear
• Heightened arousal and confusion
• Reactions
• Helplessness and passivity
• Avoidance of trauma-related reminders
• Exaggerated startle response
• Regressive symptoms
• Somatic symptoms
• Sleep disturbances, nightmares
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Infant to 5 Years: Signs of Stress
• Communication
• Cognitive confusion
• Difficulty talking about event; lack of verbalization
• Trouble identifying feelings
• Unable to understand event as permanent
• Anxieties about death
• Interactions
• Separation fears and clinging to caregivers
• Grief related to abandonment by caregiver
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
6 to 11 Years: Signs of Stress
• Behaviors
• Spacey or distracted
• Changes in behavior, mood, personality
• Regression to behavior of young child
• Aggressive behavior, angry outbursts
• Reactions
• Reminders trigger disturbing feelings
• Responsibility and guilt
• Safety concerns, preoccupation with danger
• Obvious anxiety and general fearfulness
• Somatic symptoms
• Sleep disturbances, nightmares
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
6 to 11 Years: Signs of Stress
• Communication
• Confusion and inadequate understanding of events
• Magical explanations to fill in gaps of understanding
• Withdrawn and quiet
• Interactions
• Worry and concern for others
• Separation anxiety
• Repetitious traumatic play and retelling
• Loss of ability to concentrate
• School avoidance
• Loss of interest in activities
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
12 to 18 Years: Signs of Stress
• Behaviors
• Self-consciousness
• Depression
• Trauma-driven acting out; sexual acting out or
recklessness; risk-taking; substance use/abuse
• Accident proneness
• Reactions
• Efforts to distance from feelings
• Wish for revenge and action-oriented responses
• Life-threatening re-enactment
• Decline in school performance
• Sleep and eating disturbances
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
12 to 18 Years: Signs of Stress
• Communication
• Increased self-focusing
• Social withdrawal
• Interactions
• Flight into driven activity/involvement with others OR
retreat from others in order to manage inner turmoil
• Rebellion at home and school
• Abrupt shift in relationships
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
General Coping Strategies
•Create a safe environment
•Provide consistency
•Offer reassurance and support
•Be honest about what has happened
•Explain what officials are doing (state, federal, police,
firefighters, hospital, etc.) to address the issues/concerns
•Manage your own anxiety
•Help put the event in perspective
•Ask “how are you doing?” and “what can I do for you now?”
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Specific Coping Techniques:
Infant to 2 ½ Years
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Maintain calm atmosphere
Keep familiar routines
Avoid unnecessary separations from caregivers
Minimize exposure to reminders of trauma—don’t keep TV
news on
Expect children to temporarily regress; don’t panic
Help children give simple names to big feelings
Talk about event in simple terms during brief chats
Provide simple props (doctor’s kit, toy ambulance) if trying
to play out frightening situation
Provide soothing activities
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Specific Coping Techniques:
2 1/2 to 5 Years
• Maintain familiar routines
• Don’t introduce new and
challenging experiences
• Avoid nonessential separations
from important caregivers
• Listen to and tolerate retelling
of events
• Accept and help them name
strong feelings during brief
conversations
• Respect fears and give time to
cope
• Expect regressive and
uncharacteristic behaviors—
maintain rules
• Protect from re-exposure
and reminders through
media
• Provide opportunities and
props for play
• If kids have nightmares,
explain that bad dreams
aren’t real and they’ll
happen less and less
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Specific Coping Techniques:
6-11 Years
• Listen to and tolerate retelling of events
• Respect fears; give them time to cope
• Increase awareness and monitoring of play they may secretly
reenact events with peers
• Set limits on scary or hurtful play
• Permit children to try out new ideas to deal with fearfulness at
nap or bedtime to feel safe (i.e., nightlight, radio, extra reading
time)
• Reassure that feelings of fear, or behaviors that feel out of
control, are normal after a frightening experience
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Specific Coping Techniques:
12-18 Years
• Encourage discussions about stress with each other and
adults they trust
• Reassure that strong feelings—guilt, shame, embarrassment,
desire for revenge—are normal
• Provide opportunities to spend time with supportive friends
and peers
• Help find activities that offer opportunities to experience
mastery, control, self-esteem, and pleasure (i.e., sports, art,
acting, etc.)
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Helpful Resources for Educators
Tough Topics Series and Booklet:
http://brainhealth.army.mil/SBH
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics - Deployment
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics – Homecoming
& Reunion
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics – Coping with Stress
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics – Grief, Loss and Trauma
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics – Coping with Death
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics –
Talking About Violence, Trauma & War
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Tough Topics – Fostering Resilience
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
So, what’s being done to help?
*Military Initiatives
*Civilian Resources & Assistance
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
The Army Family Covenant
• “We are committed to Improving Family
Readiness by increasing accessibility and
quality of health care.”
• “We are committed to Improving Family
Readiness by ensuring excellence in schools,
youth services and child care.”
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
CAF-BHP “Family Strong” Mission
As an integral part of the Army’s force generation
and deployment processes, the Proponency
supports and sustains comprehensive and
integrated behavioral health systems of care for
Military Children and their Families at installations
throughout the Army.
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Director CAF-BHP Intent
Purpose: To support the implementation of an integrated
comprehensive behavioral health system of care for Military
Children and Families across the Army Medical Command that
promotes prevention, resiliency building, and timely
intervention.
End State:
(1) Improved access to care (coordinated, accessible behavioral
health services for military children and families with
improved capacity);
(2) Reduction in stigma and increase in health seeking behaviors;
(3) Improved outcomes (decrease in family member psychiatric
hospitalizations, more resilient and healthy Army community,
overall decrease in use of medical services);
(4) Healthier sustainable culture for Army families.
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Director CAF-BHP Intent
Key Tasks:
•Promote coordination and integration of child and family programs at the
Army and installation level
•Develop and provide behavioral health models for schools and civilian
communities that promote prevention, early detection, and delivery of
care
•Provide coaching and training programs for primary care clinicians in the
evaluation and management of common behavioral health disorders
•Serve as a repository of knowledge and clearinghouse for overarching
guidelines and information for operation of state-of-the-art behavioral
health systems and evidence based behavioral health care for Army
Children and Families.
•Centralize and standardize data collection for needs identification,
outcomes
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Child and Family Assistance
Center (CAFAC)
•Provides direct Behavioral Health Support for Army Children
and their Families, promoting optimal military readiness,
wellness, and resilience in Army Children and Families.
•Multiple mental health resources are integrated under a
single umbrella organization to facilitate coordination of
services, and increase capacity and flexibility in delivery of
these services (eliminating stove-piping of services).
•A single point of entry can be established to make access to
care easy and simple.
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
CAFAC: A Community of Practice
1. Patients call ONE number = (???) ???-????
2. Call answered by credentialed provider = 24 / 7
Child and Adolescent
Services
Gateway/Rapid Triage
ACS
Marriage/Family
School BBH
Adult Services
Community
Resources
SARD
Chaplain
FAP/Social Work
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
School Behavioral Health (SBH)
•A comprehensive array of school behavioral health programs and
services to support Children, their Families, and the Army
Community at the schools and Child Development Centers (CDCs),
directed at promotion of optimal military readiness, and wellness
and resilience in Army Children and Families.
•Multiple behavioral health resources at the schools will be
developed and integrated through a Memorandum of Agreement
(MOA) between the MTF and the local school district(s) to facilitate
coordination of services, and increase capacity and flexibility in
delivery of these services (eliminating stove-piping of services).
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
School Behavioral Health Organizational Structure
School District
Advisory Council
School Building
Advisory
Group
School Building
Advisory
Group
School Building
Advisory
Group
School Building
Advisory
Group
Process
Action
Team
Process
Action
Team
Process
Action
Team
Process
Action
Team
Triage
Team
Triage
Team
Triage
Team
Triage
Team
Prevention, Intervention, Training & Education
Advisory Board: Regional. Provides overall guidance and
direction, quality assurance.
Advisory Group: At each school. Provides specific advise to
the SBH program, policy development, performance
improvement. Ensures effective collaboration of all care
providers.
Triage Team: At each school. Responsible for clinical
case/problem review – referral, management, monitoring.
Key Features:
-- Early detection
-- Care and prevention provided where the
child is located
-- Integrated Effort; Compliment to School
Liaison Officers, Military Family Life
Consultants, etc.
-- Opportunities for training and education
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Teacher
Counselor
Social
Worker
Principal
SBBH
Psychologist
Psychiatrist
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
School Behavioral Health Clinician
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•
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Consultation to school staff and parents
Behavioral Health Screening and Assessments
Individual Counseling for students
Educator, Parent, and Community Member
Trainings on Behavioral Health Issues
• Educational Support Groups and Counseling
• Collaboration with team members within and
outside of the school setting to support
behavioral health prevention, intervention,
treatment and insure student academic success
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Current SBH Rollout Status
• Ongoing: Schofield Barracks, Joint Base Lewis
McChord, Fort Meade, Fort Campbell (SBH),
Ft. Carson, Germany (Baumholder & Bavaria)
• Proposed for FY 11: Fort Hood, Ft. Carson, Ft.
Bliss
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Helpful Resources:
• CAF-BHP School Behavioral Health
http://brainhealth.army.mil/SBH
• Army Child, Youth and School Services
http://www.armymwr.com/family/childandyouth/default.aspx
• School Liaison Officers & Military Family Life Consultants
• Military One Source – www.militaryonesource.com
• Operation: Military Kids – www.operationmilitarykids.org
• Substance Abuse and Mental Health Services Administration
(SAMHSA): 10 Strategic Initiatives – www.samhsa.gov
• Center for School Mental Health http://csmh.umaryland.edu/
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Questions, Comments or Thoughts?
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
Child, Adolescent and Family Behavioral
Health Proponency
Mona M. Johnson MA, CPP, CDP
Director School Behavioral Health
Mona.m.johnson1@us.army.mil
253.968-4440 (direct)
253. 968-4745 (main)
Website:
http://brainhealth.army.mil/SBH
Child, Adolescent & Family
Behavioral Health Proponency (CAF-BHP)
TOUCH POINT #1
Pre-deployment Health Assessment:
120-60 days pre-deployment screening
and intervention for Soldier’s deployability
and both family & Soldier risk
assessment.
•Soldier completes questionnaire about
family.
TOUCH POINT #2
Pre-deployment brief : Family training.
Encouraged to take Global Assessment
Tool and Comprehensive Resiliency
Modules
Train/
Ready
TOUCH POINT #3
Family deployment
training and voluntary
screening
Available/
Deployed
TOUCH POINT #5
Reintegration PDHA: 6-30 days
(before block leave) redeployment
screening for risk assessment with
additional BH assessment and
wellness intervention.
•Soldier completes joint questionnaire
about Family
TOUCH POINT #8
Re-deployment brief
#2: Post Honeymoon
Family training and
voluntary screening
TOUCH POINT #7
Reintegration PDHRA: 90-180 days post re-deployment screening and
intervention for risk assessment with additional BH assessment and
wellness intervention.
•Soldier completes joint questionnaire about Family
TOUCH POINT #4
In-theater prior to re-deployment:
15-90 days screening for risk
assessment.
•Soldier completes joint
questionnaire about Family
Reset
TOUCH POINT #6
Re-deployment brief #1:
Family training and
voluntary screening
The Army Force Generation Process